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Weidner AE, Roy A, Vann K, Walczyk AC, Astapova O. Paxillin regulates androgen receptor expression associated with granulosa cell focal adhesions. Mol Hum Reprod 2024; 30:gaae018. [PMID: 38718206 PMCID: PMC11136451 DOI: 10.1093/molehr/gaae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/19/2024] [Indexed: 05/31/2024] Open
Abstract
Paxillin is a ubiquitously expressed adaptor protein integral to focal adhesions, cell motility, and apoptosis. Paxillin has also recently been implicated as a mediator of nongenomic androgen receptor (AR) signaling in prostate cancer and other cells. We sought to investigate the relationship between paxillin and AR in granulosa cells (GCs), where androgen actions, apoptosis, and focal adhesions are of known importance, but where the role of paxillin is understudied. We recently showed that paxillin knockout in mouse GCs increases fertility in older mice. Here, we demonstrate that paxillin knockdown in human granulosa-derived KGN cells, as well as knockout in mouse primary GCs, results in reduced AR protein but not reduced mRNA expression. Further, we find that both AR protein and mRNA half-lives are reduced by approximately one-third in the absence of paxillin, but that cells adapt to chronic loss of paxillin by upregulating AR gene expression. Using co-immunofluorescence and proximity ligation assays, we show that paxillin and AR co-localize at the plasma membrane in GCs in a focal adhesion kinase-dependent way, and that disruption of focal adhesions leads to reduced AR protein level. Our findings suggest that paxillin recruits AR to the GC membrane, where it may be sequestered from proteasomal degradation and poised for nongenomic signaling, as reported in other tissues. To investigate the physiological significance of this in disorders of androgen excess, we tested the effect of GC-specific paxillin knockout in a mouse model of polycystic ovary syndrome (PCOS) induced by chronic postnatal dihydrotestosterone (DHT) exposure. While none of the control mice had estrous cycles, 33% of paxillin knockout mice were cycling, indicating that paxillin deletion may offer partial protection from the negative effects of androgen excess by reducing AR expression. Paxillin-knockout GCs from mice with DHT-induced PCOS also produced more estradiol than GCs from littermate controls. Thus, paxillin may be a novel target in the management of androgen-related disorders in women, such as PCOS.
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Affiliation(s)
- Adelaide E Weidner
- Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Anna Roy
- Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Kenji Vann
- Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Ariana C Walczyk
- Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Olga Astapova
- Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Viardot-Foucault V, Zhou J, Bi D, Takinami Y, Chan JKY, Lee YH. Dehydroepiandrosterone supplementation and the impact of follicular fluid metabolome and cytokinome profiles in poor ovarian responders. J Ovarian Res 2023; 16:107. [PMID: 37268990 PMCID: PMC10239139 DOI: 10.1186/s13048-023-01166-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Poor ovarian responders (POR) are women undergoing in-vitro fertilization who respond poorly to ovarian stimulation, resulting in the retrieval of lower number of oocytes, and subsequently lower pregnancy rates. The follicular fluid (FF) provides a crucial microenvironment for the proper development of follicles and oocytes through tightly controlled metabolism and cell signaling. Androgens such as dehydroepiandrosterone (DHEA) have been proposed to alter the POR follicular microenvironment, but the impact DHEA imposes on the FF metabolome and cytokine profiles is unknown. Therefore, the objective of this study is to profile and identify metabolomic changes in the FF with DHEA supplementation in POR patients. METHODS FF samples collected from 52 POR patients who underwent IVF with DHEA supplementation (DHEA +) and without (DHEA-; controls) were analyzed using untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics and a large-scale multiplex suspension immunoassay covering 65 cytokines, chemokines and growth factors. Multivariate statistical modelling by partial least squares-discriminant regression (PLSR) analysis was performed for revealing metabolome-scale differences. Further, differential metabolite analysis between the two groups was performed by PLSR β-coefficient regression analysis and Student's t-test. RESULTS Untargeted metabolomics identified 118 FF metabolites of diverse chemistries and concentrations which spanned three orders of magnitude. They include metabolic products highly associated with ovarian function - amino acids for regulating pH and osmolarity, lipids such fatty acids and cholesterols for oocyte maturation, and glucocorticoids for ovarian steroidogenesis. Four metabolites, namely, glycerophosphocholine, linoleic acid, progesterone, and valine were significantly lower in DHEA + relative to DHEA- (p < 0.05-0.005). The area under the curves of progesterone glycerophosphocholine, linoleic acid and valine are 0.711, 0.730, 0.785 and 0.818 (p < 0.05-0.01). In DHEA + patients, progesterone positively correlated with IGF-1 (Pearson r: 0.6757, p < 0.01); glycerophosphocholine negatively correlated with AMH (Pearson r: -0.5815; p < 0.05); linoleic acid correlated with estradiol and IGF-1 (Pearson r: 0.7016 and 0.8203, respectively; p < 0.01 for both). In DHEA- patients, valine negatively correlated with serum-free testosterone (Pearson r: -0.8774; p < 0.0001). Using the large-scale immunoassay of 45 cytokines, we observed significantly lower MCP1, IFNγ, LIF and VEGF-D levels in DHEA + relative to DHEA. CONCLUSIONS In POR patients, DHEA supplementation altered the FF metabolome and cytokine profile. The identified four FF metabolites that significantly changed with DHEA may provide information for titrating and monitoring individual DHEA supplementation.
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Affiliation(s)
- Veronique Viardot-Foucault
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Jieliang Zhou
- Translational ‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Dexi Bi
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072 China
| | - Yoshihiko Takinami
- Bruker Japan, 3-9 Yokohama City, Kanagawa, 220-0022 Japan
- Present Address: Kanomax Analytical Incorportated, Shimizu Suita City, Osaka Japan
| | - Jerry. K. Y. Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
- Obstetrics and Gynaecology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Yie Hou Lee
- Translational ‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
- Obstetrics and Gynaecology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore-MIT Alliance for Research and Technoology, 1 CREATE Way, Singapore, 138602 Singapore
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Wan RSF, Ko JKY, Yung SSF, Ng EHY, Li RHW. Effect of basal serum testosterone level on the ovarian response and the cumulative live birth rate in infertile women undergoing in vitro fertilization. J Assist Reprod Genet 2023; 40:883-890. [PMID: 36856970 PMCID: PMC10224885 DOI: 10.1007/s10815-023-02749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE To evaluate the effect of basal serum testosterone levels on the ovarian response and the cumulative live birth rate of infertile women undergoing in vitro fertilization (IVF). METHODS It is a retrospective study in a university-affiliated assisted reproduction center in Hong Kong. Infertile women undergoing the first IVF cycle in the center between December 2012 and November 2016 with archived serum samples and available information on cumulative live birth were included for the analysis. RESULTS A total of 1122 women were included for analysis. The median basal serum testosterone level was 0.53 (25-75th percentile: 0.40-0.67) nmol/L. Women with higher basal serum testosterone levels required a lower total dosage of gonadotrophin and a shorter duration of stimulation and had more oocytes retrieved. The cumulative live birth rates did not differ among women with serum testosterone levels in the four quartiles. Basal serum testosterone level was not a significant independent predictor of the cumulative live birth after adjusted for the women's age and number of normally fertilized oocytes in a binary logistic regression. The areas under the receiver operative characteristics (ROC) curves in predicting low or high ovarian response and the cumulative live birth were all below 0.6. CONCLUSION Higher basal serum testosterone levels were associated with a better ovarian response but had no effect on the cumulative live birth rate of infertile women undergoing IVF.
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Affiliation(s)
- Rebecca S F Wan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam Road, Hong Kong, China
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong, China
| | - Jennifer K Y Ko
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Sofie S F Yung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Ernest H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Raymond H W Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam Road, Hong Kong, China.
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Li L, Wang H, Yao Y, Cao J, Jiang Z, Yan W, Chu X, Li Q, Lu M, Ma H. The sex steroid precursor dehydroepiandrosterone prevents nonalcoholic steatohepatitis by activating the AMPK pathway mediated by GPR30. Redox Biol 2021; 48:102187. [PMID: 34781165 PMCID: PMC8604675 DOI: 10.1016/j.redox.2021.102187] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/15/2022] Open
Abstract
The prevalence of nonalcoholic steatohepatitis (NASH) caused by estrogen deficiency increased sharply in recent decades and has become a major threat to liver health in postmenopausal women. There is no effective strategy to control the incidence and development of NASH. Dehydroepiandrosterone (DHEA) is the most abundant circulating steroid with immune and metabolic regulatory properties, and its level markedly declines with increasing age in humans. Importantly, DHEA can convert into active sex hormones depending on the local needs of target tissues with little diffusion, which serves to avoid systemic side-effects from other tissues' exposure to estrogen. Here, we found that DHEA prevented the incidence and development of NASH, which is characterized by the reduction of hepatic steatosis, fibrosis, and inflammation in female mice fed with high-fat/high-cholesterol diets and effectively attenuated lipid accumulation, inflammatory response, and oxidative stress in palmitic acid-challenged hepatocytes. Mechanistically, in vitro and in vivo studies showed that the anti-NASH function of DHEA depended on its biotransformation into estrogen rather than androgen, and which up-regulates the expression of G protein-coupled estrogen receptor (GPR30), a non-classical estrogen receptor. The activation of GPR30-mediated AMP-activated protein kinase signaling is a necessary prerequisite for the alleviative effects of DHEA on NASH. Collectively, our data show the mechanisms of DHEA treatment and its effects on NASH that were previously overlooked; the data also show that GPR30 can be used as a target for treating lipid metabolism disorders and related diseases, such as NASH. Furthermore, these findings have the potential to help researchers develop new strategies for preventing NASH in postmenopausal women.
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Affiliation(s)
- Longlong Li
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Hongjun Wang
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Yao Yao
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Ji Cao
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Zhihao Jiang
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Weiyuan Yan
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Xu Chu
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Qian Li
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Miaomiao Lu
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Haitian Ma
- Key Laboratory of Animal Physiology and Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China.
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Aly J, Plowden TC, Christy AY. Factors contributing to persistent disparate outcomes of in vitro fertilization treatment. Curr Opin Obstet Gynecol 2021; 33:335-342. [PMID: 34101661 DOI: 10.1097/gco.0000000000000726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Disparate healthcare outcomes are ubiquitous and occur across all fields of medicine, specifically for racial and ethnic minorities. Within reproductive health, minority women face disparate access to care, particularly infertility services, poor outcomes of fertility treatment, alarmingly higher rates of maternal morbidity and mortality as well as higher rates of preterm birth, lower live birth rates when they conceive spontaneously or when they conceive with assisted reproductive technology. The objective of this review is to highlight factors contributing to the persistent racial/ethnic disparities in in vitro fertilization (IVF) outcomes. RECENT FINDINGS Recent studies document poorer outcomes after IVF treatment. Black women have been shown to have lower live birth rates following IVF treatment for more than 15 years. SUMMARY In an effort to better understand these negative outcomes, scientists and clinicians have investigated possible biological contributing factors including the vaginal microbiome, differences in oocyte quality, embryo viability, endometrial factors, and hormonal differences. Multiple social/cultural factors also play a role including access to care, particularly for people with low income, patient (mis)education, and medical racism/bias.
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Affiliation(s)
- Jasmine Aly
- Program in Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Torie C Plowden
- Department of Gynecologic Surgery and Obstetrics, Womack Army Medical Center, Fort Bragg, North Carolina
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Abstract
Supplemental Digital Content is available in the text Objective: This meta-analysis aims to investigate serum androgen profiles (testosterone, dehydroepiandrosterone sulfate, androstenedione, and sex hormone-binding globulin) in women with premature ovarian failure and to establish if there is evidence of diminished androgen levels in these women. Methods: Various Internet sources of PubMed, Cochrane library, and Medline were searched systematically until February, 2018. Out of a pool of 2,461 studies, after applying the inclusion/exclusion criterion, 14, 8, 10, and 9 studies were chosen for testosterone, dehydroepiandrosterone sulfate, androstenedione, and sex hormone-binding globulin, respectively, for this meta-analysis. The effect measure was the standardized mean difference with 95% confidence interval (95% CI) in a random-effects model. Results: The testosterone concentrations in premature ovarian insufficiency were compared with fertile controls: stamdard mean difference (IV, random, 95% CI) −0.73 [−0.99, −0.46], P value < 0.05. The dehydroepiandrosterone sulfate concentrations in premature ovarian insufficiency compared to fertile controls: standard mean difference (IV, random, 95% CI) −0.65 [−0.92, −0.37], P value < 0.05. Androstenedione in premature ovarian insufficiency were compared with fertile controls: standard mean difference (IV, random, 95% CI) −1.09 [−1.71, −0.48], P value < 0.05. Sex hormone-binding globulin levels did not show statistical significance. The dehydroepiandrosterone sulfate levels were reduced in premature ovarian insufficiency cases, but still showed a higher level than in postmenopausal women. Conclusions: Women with premature ovarian insufficiency are at risk for decreased concentrations of testosterone, dehydroepiandrosterone sulfate, and androstenedione. Dehydroepiandrosterone sulfate levels were more reduced in postmenopausal controls when compared with premature ovarian insufficiency cases.
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Xu Y, Gao Y, Huang Z, Zheng Y, Teng W, Zheng D, Zheng X. LKB1 suppresses androgen synthesis in a mouse model of hyperandrogenism via IGF-1 signaling. FEBS Open Bio 2019; 9:1817-1825. [PMID: 31433577 PMCID: PMC6768104 DOI: 10.1002/2211-5463.12723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/30/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a major cause of anovulatory sterility in women, and most PCOS patients exhibit hyperandrogenism (HA). Liver kinase b1 (LKB1) is a tumor suppressor that has recently been reported to be involved in PCOS. However, the mechanism by which LKB1 affects HA has not previously been elucidated. We report here that ovarian LKB1 levels are significantly decreased in a female mouse model of HA. Moreover, we report that LKB1 expression is inhibited by elevated androgens via activation of androgen receptors. In addition, LKB1 treatment was observed to suppress androgen synthesis in theca cells and promote estrogen production in granulosa cells by regulating steroidogenic enzyme expression. As expected, LKB1 knockdown inhibited estrogen levels and enhanced androgen levels, and LKB1‐transgenic mice were protected against HA. The effect of LKB1 appears to be mediated via IGF‐1 signaling. In summary, we describe here a key role for LKB1 in controlling sex hormone levels.
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Affiliation(s)
- Ying Xu
- Department of Obstetrics and Gynecology, the 476th Hospital of PLA, Fuzhou, China.,Fuzong Clinical College, Fujian Medical University, Fuzhou, China
| | - Yongxing Gao
- Department of Obstetrics and Gynecology, Zhongda Hospital Southeast University, Nanjing, China
| | - Zufang Huang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou, China
| | - Yan Zheng
- Department of Obstetrics and Gynecology, the 476th Hospital of PLA, Fuzhou, China
| | - Wenjuan Teng
- Department of Obstetrics and Gynecology, the 476th Hospital of PLA, Fuzhou, China
| | - Deyan Zheng
- Department of Obstetrics and Gynecology, the 476th Hospital of PLA, Fuzhou, China
| | - Xiaohua Zheng
- Department of Obstetrics and Gynecology, the 476th Hospital of PLA, Fuzhou, China
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Kushnir VA, Darmon SK, Barad DH, Weghofer A, Gleicher N. Effects of dehydroepiandrosterone (DHEA) supplementation on sexual function in premenopausal infertile women. Endocrine 2019; 63:632-638. [PMID: 30311171 DOI: 10.1007/s12020-018-1781-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the effects of dehydroepiandrosterone (DHEA) supplementation on female sexual function in premenopausal infertile women of advanced ages. METHODS This observational study was conducted in an academically affiliated private fertility center. Patients included 87 premenopausal infertile women, 50 of whom completed the study including the Female Sexual Function Index (FSFI) questionnaires and comprehensive endocrine evaluation before and 4-8 weeks after initiating 25 mg of oral micronized DHEA TID. RESULTS Age of patients was 41.1 ± 4.2 years, BMI 24.4 ± 6.1 kg/m2, 86% were married, and 42% were parous. Following supplementation with DHEA, all serum androgen levels increased (each P < 0.0001), while FSH levels decreased by 2.6 ± 4.4 from a baseline of 10.3 ± 5.4 mIU/mL (P = 0.009). The FSFI score for the whole study group increased by 7% (from 27.2 ± 6.9 to 29.2 ± 5.6; P = 0.0166). Domain scores for desire increased by 17% (P = 0.0004) and by 12% for arousal (P = 0.0122); lubrication demonstrated an 8% trend towards improvement (P = 0.0551), while no changes in domain scores for orgasm, satisfaction, or pain were observed. Women in the lowest starting FSFI score quartile (<25.7), experienced a 6.1 ± 8.0 (34%) increase in total FSFI score following DHEA supplementation. Among these women, improvements in domain categories were noted for desire (40%), arousal (46%), lubrication (33%), orgasm (54%), satisfaction (24%), and pain (25%). CONCLUSIONS This uncontrolled observational study implies that supplementation with DHEA improves sexual function in older premenopausal women with low baseline FSFI scores.
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Affiliation(s)
- Vitaly A Kushnir
- The Center for Human Reproduction, New York, NY, USA.
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | | | - David H Barad
- The Center for Human Reproduction, New York, NY, USA
- Foundation for Reproductive Medicine, New York, NY, USA
| | - Andrea Weghofer
- The Center for Human Reproduction, New York, NY, USA
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY, USA
- Foundation for Reproductive Medicine, New York, NY, USA
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA
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The impact of genome variation and diet on the metabolic phenotype and microbiome composition of Drosophila melanogaster. Sci Rep 2018; 8:6215. [PMID: 29670218 PMCID: PMC5906449 DOI: 10.1038/s41598-018-24542-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/05/2018] [Indexed: 12/19/2022] Open
Abstract
The metabolic phenotype of an organism depends on a complex regulatory network, which integrates the plethora of intrinsic and external information and prioritizes the flow of nutrients accordingly. Given the rise of metabolic disorders including obesity, a detailed understanding of this regulatory network is in urgent need. Yet, our level of understanding is far from completeness and complicated by the discovery of additional layers in metabolic regulation, such as the impact of the microbial community present in the gut on the hosts’ energy storage levels. Here, we investigate the interplay between genome variation, diet and the gut microbiome in the shaping of a metabolic phenotype. For this purpose, we reared a set of fully sequenced wild type Drosophila melanogaster flies under basal and nutritionally challenged conditions and performed metabolic and microbiome profiling experiments. Our results introduce the fly as a model system to investigate the impact of genome variation on the metabolic response to diet alterations and reveal candidate single nucleotide polymorphisms associated with different metabolic traits, as well as metabolite-metabolite and metabolite-microbe correlations. Intriguingly, the dietary changes affected the microbiome composition less than anticipated. These results challenge the current view of a rapidly changing microbiome in response to environmental fluctuations.
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Gleicher N, Kushnir VA, Barad DH. Impact of androgen supplementation on the follicular endocrine milieu in women with hypoandrogenism. Reprod Biomed Online 2018; 36:719-720. [PMID: 29598847 DOI: 10.1016/j.rbmo.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, New York, 10021, USA; The Foundation for Reproductive Medicine, New York, New York 10020, USA; Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, New York 10016, USA; Department of Obstetrics and Gynecology, Vienna University School of Medicine, 1090 Vienna, Austria.
| | - Vitaly A Kushnir
- The Center for Human Reproduction, New York, New York, 10021, USA; Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem VAK, North Carolina 27101, USA
| | - David H Barad
- The Center for Human Reproduction, New York, New York, 10021, USA; The Foundation for Reproductive Medicine, New York, New York 10020, USA
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Gonda KJ, Domar AD, Gleicher N, Marrs RP. Insights from clinical experience in treating IVF poor responders. Reprod Biomed Online 2017; 36:12-19. [PMID: 29223475 DOI: 10.1016/j.rbmo.2017.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/27/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022]
Abstract
'Poor responders' is a term used to describe a subpopulation of IVF patients who do not respond well to ovarian stimulation with gonadotrophins. While there is no standard definition of a poor responder, these patients tend to be of advanced maternal age (≥40 years), have a history of poor ovarian response with conventional stimulation protocols, and/or have low ovarian reserve. Despite the heterogeneity of this patient group, there are characteristics and needs common to many poor responders that can be addressed through a holistic approach. Stimulation during the earlier stages of follicle maturation may help synchronize follicle development for improved response to later gonadotrophin stimulation, and supplementation with dehydroepiandrosterone or human growth hormone may promote early follicle development in poor responders. IVF protocols should be specifically tailored to poor responders to complement the patient's natural cycle. Because poor responders tend to have high levels of stress and anxiety, patients should receive psychological counselling and support, both prior to and during IVF cycles, to ensure optimal outcomes and improve patients' experience. It is important to set realistic expectations with poor responders and their partners to help patients make informed decisions and better manage their distress and anxiety.
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Affiliation(s)
| | - Alice D Domar
- Domar Center for Mind/Body Health, Waltham, MA, USA; Boston IVF, Waltham, MA, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Norbert Gleicher
- Center for Human Reproduction, New York, NY, USA; Foundation for Reproductive Medicine, New York, NY, USA; Rockefeller University, New York, NY, USA; Medical University of Vienna, Vienna, Austria
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Kushnir VA, Seifer DB, Barad DH, Sen A, Gleicher N. Potential therapeutic applications of human anti-Müllerian hormone (AMH) analogues in reproductive medicine. J Assist Reprod Genet 2017; 34:1105-1113. [PMID: 28643088 PMCID: PMC5581791 DOI: 10.1007/s10815-017-0977-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/07/2017] [Indexed: 11/25/2022] Open
Abstract
Members of the transforming growth factor-beta (TGF-beta) superfamily are key regulators of various physiological processes. Anti-Müllerian hormone (AMH) which is also commonly known as Müllerian-inhibiting substance (MIS) is a member of the TGF-beta superfamily and an important regulator of reproductive organ differentiation and ovarian follicular development. While AMH has been used for diagnostic purposes as a biomarker for over 15 years, new potential therapeutic applications of recombinant human AMH analogues are now emerging as pharmacologic agents in reproductive medicine. Therapeutic uses of AMH in gonadal tissue may provide a unique opportunity to address a broad range of reproductive themes, like contraception, ovulation induction, onset of menopause, and fertility preservation, as well as specific disease conditions, such as polycystic ovarian syndrome (PCOS) and cancers of the reproductive tract. This review explores the most promising therapeutic applications for a novel class of drugs known as AMH analogues with agonist and antagonist functions.
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Affiliation(s)
- Vitaly A Kushnir
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - David B Seifer
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - David H Barad
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, USA
| | - Aritro Sen
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, USA
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, Vienna, Austria
- The Rockefeller University, New York, NY, USA
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Shapiro AJ, Darmon SK, Barad DH, Albertini DF, Gleicher N, Kushnir VA. Effect of race and ethnicity on utilization and outcomes of assisted reproductive technology in the USA. Reprod Biol Endocrinol 2017; 15:44. [PMID: 28595591 PMCID: PMC5465464 DOI: 10.1186/s12958-017-0262-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/30/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the utilization and live birth rates of assisted reproductive technology (ART) modalities among various racial and ethnic groups in recent years. METHODS We reviewed ART data reported to the Society for Assisted Reproductive Technologies Clinic Outcome Reporting System (SART CORS) for autologous ART and third-party ART (3ART) cycles which involved donor oocytes, sperm, embryos and gestational carrier, performed in the U.S. between 2004 and 2013. To gauge demand by various racial/ethnic groups for ART services, we examined fertility rates and demographics of the entire U.S. birth cohort over the same time interval. RESULTS Of 1,132,844 autologous ART cycles 335,462 resulted in a live birth (29.6%). An additional, 217,030 3ART cycles resulted in 86,063 live births (39.7%). Hispanic and Black women demonstrated high fertility and lower utilization rates of autologous ART and 3ART. Caucasian and Asian women exhibited lower fertility rates and higher autologous ART and 3ART utilization. Autologous ART resulted in higher live birth rates among Caucasian and Hispanic women and lower rates among Asian and especially Black women. 3ART improved live birth rates in all races/ethnicities, though Black women experienced lower live birth rates with most modalities. Spontaneous abortion rates were higher among Black women following autologous ART and some 3ART modalities than those among Caucasian women. CONCLUSION Utilization of ART is inversely related to fertility rates. Autologous ART produces lower live birth rates among Asian and Black women. 3ART results in relatively low live birth rates among Black women. TRIAL REGISTRATION SART CORS #57 , Registered 5/14/2015.
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Affiliation(s)
- Alice J. Shapiro
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Obstetrics, Gynecology & Women’s Health, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Sarah K. Darmon
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - David H. Barad
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
| | - David F. Albertini
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY USA
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, Vienna, Austria
| | - Vitaly A. Kushnir
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC USA
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Liu Y, Du SY, Ding M, Dou X, Zhang FF, Wu ZY, Qian SW, Zhang W, Tang QQ, Xu CJ. The BMP4-Smad signaling pathway regulates hyperandrogenism development in a female mouse model. J Biol Chem 2017; 292:11740-11750. [PMID: 28572510 DOI: 10.1074/jbc.m117.781369] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/31/2017] [Indexed: 11/06/2022] Open
Abstract
Polycystic ovary syndrome is a common endocrine disorder and a major cause of anovulatory sterility in women at reproductive age. Most patients with polycystic ovary syndrome have hyperandrogenism, caused by excess androgen synthesis. Bone morphogenetic protein 4 (BMP4) is an essential regulator of embryonic development and organ formation, and recent studies have also shown that BMP4 may be involved in female steroidogenesis process. However, the effect of BMP4 on hyperandrogenism remains unknown. Here, using a female mouse model of hyperandrogenism, we found that ovarian BMP4 levels were significantly decreased in hyperandrogenism. Elevated androgens inhibited BMP4 expression via activation of androgen receptors. Moreover, BMP4 treatment suppressed androgen synthesis in theca cells and promoted estrogen production in granulosa cells by regulating the expression of steroidogenic enzymes, including CYP11A, HSD3B2, CYP17A1, and CYP19A1 Consistently, knockdown of BMP4 augmented androgen levels and inhibited estrogen levels. Mechanistically, Smad signaling rather than the p38 MAPK pathway regulated androgen and estrogen formation, thereby mediating the effect of BMP4. Of note, BMP4-transgenic mice were protected against hyperandrogenism. Our observations clarify a vital role of BMP4 in controlling sex hormone levels and offer new insights into intervention for managing hyperandrogenism by targeting the BMP4-Smad signaling pathway.
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Affiliation(s)
- Yang Liu
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China; Key Laboratory of Metabolism and Molecular Medicine, the Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Shao-Yue Du
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China
| | - Meng Ding
- Key Laboratory of Metabolism and Molecular Medicine, the Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Xin Dou
- Key Laboratory of Metabolism and Molecular Medicine, the Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Fei-Fei Zhang
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China
| | - Zhi-Yong Wu
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China
| | - Shu-Wen Qian
- Key Laboratory of Metabolism and Molecular Medicine, the Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Wei Zhang
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China
| | - Qi-Qun Tang
- Key Laboratory of Metabolism and Molecular Medicine, the Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai 200032, China.
| | - Cong-Jian Xu
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China.
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Vega M, Barad DH, Yu Y, Darmon SK, Weghofer A, Kushnir VA, Gleicher N. Anti-mullerian hormone levels decline with the presence of antiphospholipid antibodies. Am J Reprod Immunol 2016; 76:333-7. [DOI: 10.1111/aji.12551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 07/22/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Mario Vega
- The Center for Human Reproduction; New York NY USA
- Department of Obstetrics and Gynecology; Albert Einstein College of Medicine; Bronx NY USA
| | - David H. Barad
- The Center for Human Reproduction; New York NY USA
- Department of Obstetrics and Gynecology; Albert Einstein College of Medicine; Bronx NY USA
- Foundation for Reproductive Medicine; New York NY USA
| | - Yao Yu
- The Center for Human Reproduction; New York NY USA
| | | | - Andrea Weghofer
- The Center for Human Reproduction; New York NY USA
- Department of Obstetrics and Gynecology; Vienna University School of Medicine; Vienna Austria
| | - Vitaly A. Kushnir
- The Center for Human Reproduction; New York NY USA
- Department of Obstetrics and Gynecology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Norbert Gleicher
- The Center for Human Reproduction; New York NY USA
- Foundation for Reproductive Medicine; New York NY USA
- Department of Obstetrics and Gynecology; Vienna University School of Medicine; Vienna Austria
- Laboratory for Stem Cell Biology and Molecular Embryology; The Rockefeller University; New York NY USA
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16
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Gleicher N, Kushnir VA, Albertini DF, Barad DH. Improvements in IVF in women of advanced age. J Endocrinol 2016; 230:F1-6. [PMID: 27154334 DOI: 10.1530/joe-16-0105] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/06/2016] [Indexed: 11/08/2022]
Abstract
Women above age 40 years in the US now represent the most rapidly growing age group having children. Patients undergoing in vitro fertilization (IVF) are rapidly aging in parallel. Especially where egg donations are legal, donation cycles, therefore, multiply more rapidly than autologous IVF cycles. The donor oocytes, however, are hardly ever a preferred patient choice. Since with use of own eggs, live birth rates decline with advancing age but remain stable (and higher) with donor eggs, older patients always face the difficult and very personal choice between poorer chances with own and better chances with donor oocytes. Physician contribution to this decision should in our opinion be restricted to accurate outcome information for both options. Achievable pregnancy and live birth rates in older women are, however, frequently underestimated, thereby mistakenly biasing fertility providers, private insurance companies and even regulatory government agencies. Restriction on access to IVF for older women is then often the consequence. In this review, we summarize the limited published data on best treatments of 'older' ovaries, while also addressing treatment approaches that should be avoided in older women. This focused review, therefore, to a degree is subjective. Research addressing aging ovaries in IVF has been disappointingly sparse, and has in our opinion too heavily concentrated on methods of embryo selection (ES), which, especially in older women, not only fail to improve IVF outcomes, but actually, negatively affect live birth chances. We conclude that, aside from breakthroughs in gamete creation, only pharmacological interventions into early (small growing follicle stages) follicle maturation will offer new potential to positively impact oocyte and embryo quality and, therefore, IVF outcomes. Research, therefore, should be accordingly redirected.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human ReproductionNew York, New York, USA The Foundation for Reproductive MedicineNew York, New York, USA The Brivanlou Stem Cell Biology and Molecular Embryology LaboratoryThe Rockefeller University, New York, New York, USA
| | - Vitaly A Kushnir
- The Center for Human ReproductionNew York, New York, USA Department of Obstetrics and GynecologyWake Forest University, Winston Salem, North Carolina, USA
| | - David F Albertini
- The Center for Human ReproductionNew York, New York, USA Department of Molecular and Integrative PhysiologyThe University of Kansas Medical Center, Kansas City, Kansas, USA
| | - David H Barad
- The Center for Human ReproductionNew York, New York, USA The Foundation for Reproductive MedicineNew York, New York, USA
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Is vaginal administration the “way out” of the hormone of controversy? Menopause 2016; 23:235. [DOI: 10.1097/gme.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Xiao S, Li Y, Long L, Luo C, Mai Q. Basal serum testosterone levels correlate with ovarian reserve and ovarian response in cycling women undergoing in vitro fertilization. Gynecol Endocrinol 2016; 32:51-4. [PMID: 26299634 DOI: 10.3109/09513590.2015.1076784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the association between basal serum testosterone levels and in vitro fertilization (IVF) parameters in cycling women. A retrospective cohort study was performed at a clinical IVF center, and 495 women with regular menstruation were enrolled. Serum testosterone levels were measured before the start of IVF treatment cycle. We found that basal serum testosterone levels were negatively associated with female age and FSH/LH ratios. In contrast, we found a positive correlation between serum testosterone levels and the number of oocytes and available embryos. However, there was no significant association between testosterone levels and pregnancy outcome. Our results suggest that basal serum testosterone levels were significantly related to certain classic indicators of ovarian reserve, such as age and FSH/LH ratios. Increased testosterone levels improved ovarian response in cycling women, but they fail to predict pregnancy and miscarriage rate.
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Affiliation(s)
- Shan Xiao
- a Reproductive Medicine Center, First Affiliated Hospital of Sun Yat-Sen University , Guangdong , People's Republic of China
- b Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation , Fertility Center, Shenzhen Zhongshan Urology Hospital , Guangdong , People's Republic of China
| | - Yubin Li
- a Reproductive Medicine Center, First Affiliated Hospital of Sun Yat-Sen University , Guangdong , People's Republic of China
| | - Lingli Long
- c Translational Medicine Center, First Affiliated Hospital of Sun Yat-Sen University , Guangdong , People's Republic of China , and
| | - Canqiao Luo
- d Department of Pathology , First Affiliated Hospital of Sun Yat-Sen University , Guangdong , People's Republic of China
| | - Qingyun Mai
- a Reproductive Medicine Center, First Affiliated Hospital of Sun Yat-Sen University , Guangdong , People's Republic of China
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19
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Gleicher N, Vega MV, Darmon SK, Weghofer A, Wu YG, Wang Q, Zhang L, Albertini DF, Barad DH, Kushnir VA. Live-birth rates in very poor prognosis patients, who are defined as poor responders under the Bologna criteria, with nonelective single embryo, two-embryo, and three or more embryos transferred. Fertil Steril 2015; 104:1435-41. [PMID: 26348275 DOI: 10.1016/j.fertnstert.2015.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine live-birth rates (LBRs) at various ages in very poor prognosis patients, who are defined as poor responders under the Bologna criteria. DESIGN Retrospective cohort study. SETTING Academically affiliated private fertility center. PATIENT(S) Among 483 patients, who under the Bologna criteria (three or fewer oocytes, >40 years of age, and/or antimüllerian hormone [AMH] <1.1 ng/mL [2/3 criteria minimum]) were poor responders, 278 (381 fresh IVF cycles) qualified for the study because they had at least one embryo on day 3 for transfer. INTERVENTION(S) IVF cycles in women with low functional ovarian reserve, involving androgen and CoQ10 supplementation and ovarian stimulation with daily gonadotropin dosages of 300-450 IU of FSH and 150 IU of hMG in microdose agonist cycles. MAIN OUTCOME MEASURE(S) Age-specific LBRs per ET. RESULT(S) Ages did not differ between nonelective (ne) single ET (SET), ne2-ET, and ne ≥ 3-ET cycles (41.3 ± 3.9, 41.7 ± 3.1, and 42.4 ± 2.1 years, respectively). Patients with neSETs demonstrated significantly lower AMH and higher FSH levels and required higher gonadotropin dosages than ne2-ET and ne ≥ 3-ET patients. LBRs declined with age. Above age 42, three or more embryos are required to achieve reasonable LBRs and two or more to avoid futility under American Society for Reproductive Medicine (ASRM) guidelines. CONCLUSION(S) Very poor prognosis patients can still achieve acceptable pregnancy rates at least till their mid-40s if they reach ET. The degree to which egg donation is emphasized as the only treatment option in such patients, therefore, requires reconsideration. Above age 42, at least two, and preferably three embryos, are however required to exceed futility, as defined by ASRM.
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Affiliation(s)
- Norbert Gleicher
- Center for Human Reproduction, New York, New York; Foundation for Reproductive Medicine, New York, New York; Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, New York.
| | - Mario V Vega
- Center for Human Reproduction, New York, New York; Department of Obstetrics and Gynecology, Mount Sinai St. Lukes-Roosevelt Hospital, New York, New York
| | | | - Andrea Weghofer
- Center for Human Reproduction, New York, New York; Vienna University School of Medicine, Vienna, Austria
| | - Yan-Guan Wu
- Center for Human Reproduction, New York, New York
| | - Qi Wang
- Center for Human Reproduction, New York, New York
| | - Lin Zhang
- Center for Human Reproduction, New York, New York
| | - David F Albertini
- Center for Human Reproduction, New York, New York; Department of Molecular and Integrative Physiology, University of Kansas School of Medicine, Wichita, Kansas
| | - David H Barad
- Center for Human Reproduction, New York, New York; Foundation for Reproductive Medicine, New York, New York; Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York
| | - Vitaly A Kushnir
- Center for Human Reproduction, New York, New York; Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, North Carolina
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Affiliation(s)
- Aya Shohat-Tal
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
| | - Aritro Sen
- Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - David H Barad
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
| | - Vitaly A Kushnir
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA
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Affiliation(s)
- Michał Kunicki
- INVICTA Fertility and Reproductive Center, ul. Trzy Lipy 3, 80-172 Gdansk, Poland
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland
| | - Joanna Liss
- INVICTA Fertility and Reproductive Center, ul. Trzy Lipy 3, 80-172 Gdansk, Poland
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